Since January 1, 2016, all private sector companies are required to offer collective health insurance to their employees. From now on, it is no longer a simple option, but a real pillar of social protection. For the company, the system becomes a lever for loyalty and attractiveness.
Definition and legal framework
Taken out with an insurance organization, compulsory employer mutual insurance aims to improve employee health coverage. By supplementing Social Security reimbursements on main medical expensesit reduces the remainder payable by policyholders. Unlike individual complementary health insurance, collective mutual insurance protects the company’s employees and managers thanks to guarantees adapted to the specificities of the structure and/or sector of activity.
Entering into force on January 1, 2016, the ANI law (National Interprofessional Agreement) requires employers in the private sector to offer complementary collective health insurance to their employees, except exceptions provided for by the legislator. This obligation applies upon hiring the first employeeregardless of the type of employment contract, from the first day of work. It is aimed at permanent and fixed-term employees, temporary workers, part-time employees and apprentices. Mutual insurance is therefore mandatory for structures with fewer than 10 employees. Please note that group health coverage can also extend to the employee’s dependents. This option remains optional for the employer.
The implementation methods
The implementation of compulsory complementary health insurance is done in several ways:
- through a collective agreement or a branch agreement ;
- through the organization of a vote by referendum with employees in order to validate or not a collective agreement;
- by unilateral decision of the employer when health coverage has not been established by referendum or collective agreement.
Financial participation from the employer
Concerning the financing of compulsory mutual insurance, the employer takes charge at least 50% of the cost of complementary health insuranceeven if it exceeds the minimum coverage. The rest will be the responsibility of the employee or, in most cases, by Social Security. Of course, the company is allowed to offer a higher participation, up to 100% of the contributions, according to its possibilities. It happens, in fact, that this decision is provided for by the branch agreement or the collective agreement.
The financial implication of the employer is exempt from social charges. The exemption limited to 6% of the annual Social Security ceiling (PASS) is supplemented by 1.5% of the employee’s annual gross remuneration. The overall amount does not exceed 12% of the PASS, or the equivalent of €47,100 in 2025. The company’s share of contribution is also deductible from its tax result. On the other hand, it remains subject to the CSG and the CRDS at 9.7%. A contribution of 8% applies to the social package.
Mandatory minimum guarantees
The employer undertakes to offer a minimal care basket to each beneficiary. Although the level of coverage depends on the contract chosen, certain guarantees are required for the majority of group health supplements:
- L’full co-payment payable by policyholders relating to consultations, procedures and services reimbursed by Health Insurance;
- there full hospital daily ratewith accommodation costs and comfort services such as a single room according to the contract;
- THE dental costs including prostheses and orthodontics at 125% of the conventional rate,
- THE optical costs on a fixed basis per period of two years or one year for minors and in the event of changes in the correction, i.e. €100 for simple lenses and up to €200 for complex lenses.
In addition to the mandatory minimum guarantees, collective health insurance can also provide additional services such as:
- THE third-party payer ;
- a few support services such as childcare or housekeeping;
- of the support and/or prevention systemsto name only the coverage of costs related to screening for certain diseases.
Can an employee refuse compulsory company mutual insurance?
The company is subject to the obligation to offer complementary mutual insurance to all of its employees. On the other hand, the law provides for certain cases of exemption:
- an employee benefiting from Supplementary solidarity health insurance (CSS)and this, until the end of his right to this assistance;
- an employee taking advantage of collective coverage as a beneficiary ;
- A multi-employer employee covered by a collective contract with one of these companies;
- an employee who has already subscribed to a individual mutual insurance at the time of hiring, and the exemption extends until the anniversary date of the health coverage contract;
- an employee hired in Fixed-term contract or subject to a mission contract of less than 3 months ;
- A apprentice or a very part-time employeeworking 15 hours or less per week, and whose contribution represents more than 10% of their salary.
Please note that membership exemptions are not automatic. It is up to the employee concerned to make the written request and provide the supporting documents necessary.
